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Monday, April 27, 2009

Shortage of Doctors an Obstacle to Obama Goals

Shortage of Doctors an Obstacle to Obama Goals
By ROBERT PEAR

WASHINGTON — Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.

Some of the proposed solutions, while advancing one of President Obama’s goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care but could make it more difficult to rein in costs.

The need for more doctors comes up at almost every Congressional hearing and White House forum on health care. “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.

Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. “We don’t have enough doctors in primary care or in any specialty,” said Representative Shelley Berkley, Democrat of Nevada.

Senator Orrin G. Hatch, Republican of Utah, said, “The work force shortage is reaching crisis proportions.”

Even people with insurance have problems finding doctors.

Miriam Harmatz, a lawyer in Miami, said: “My longtime primary care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low.”

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Senator Max Baucus, a Montana Democrat and chairman of the Finance Committee, said Medicare payments were skewed against primary care doctors — the very ones needed to coordinate the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer’s disease.

“Primary care physicians are grossly underpaid compared with many specialists,” said Mr. Baucus, who vowed to increase primary care payments as part of legislation to overhaul the health care system.

The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services, an idea that riles many specialists.

Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: “We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way.

“If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”

The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year.

“If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older,” said Dr. Atul Grover, the chief lobbyist for the association. “Let’s say we insure everyone. What next? We won’t be able to take care of all those people overnight.”

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased.

“Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation.

The ratio of primary care doctors to population is higher in Massachusetts than in other states.

Increasing the supply of doctors could have major implications for health costs.

“It’s completely reasonable to say that adding more physicians to the work force is likely to increase health spending,” Dr. Grover said.

But he said: “We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary.”

In many parts of the country, specialists are also in short supply.

Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque.

“It’s a long, exhausting drive, three hours down and three hours back,” Ms. Schuster said.

The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said neighboring Custer County had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.

The Obama administration is pouring hundreds of millions of dollars into community health centers.

But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.

Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.

Monday, April 20, 2009

Saturday, April 18, 2009

The real story of Obama's Decision Making with the hostages.

I personally can not verify this story, but it sounds more realistic based
on my experience with American Military Personnel.
I've also always had the highest respect for the SEALs so I'm possibly
biased.

Anyway, this is the email I received today. You judge for yourself!~

This came from a reliable source with a different account of how the SEAL
team and the Navy took out the three Somali pirates.

Subject: Ah, now the truth comes out

Having spoken to some SEAL pals here in Virginia Beach yesterday and asking
why this thing dragged out for 4 days, I got the following:

1. BHO wouldn't authorize the DEVGRU/NSWC SEAL teams to the scene for 36
hours going against OSC (on scene commander) recommendation.
2. Once they arrived, BHO imposed restrictions on their ROE that they
couldn't do anything unless the hostage's life was in "imminent" danger
3. The first time the hostage jumped, the SEALS had the raggies all sighted
in, but could not fire due to ROE restriction
4. When the navy RIB came under fire as it approached with supplies, no
fire was returned due to ROE restrictions. As the raggies were shooting at
the RIB, they were exposed and the SEALS had them all dialed in.
5. BHO specifically denied two rescue plans developed by the Bainbridge CPN
and SEAL teams
6. Bainbridge CPN and SEAL team CDR finally decide they have the OpArea and
OSC authority to solely determine risk to hostage. 4 hours later, 3 dead
raggies
7. BHO immediately claims credit for his "daring and decisive" Behaviour.
As usual with him, it's BS.

Read the following accurate account.

Philips' first leap into the warm, dark water of the Indian Ocean hadn't
worked out as well. With the Bainbridge in range and a rescue by his country's
Navy possible, Philips threw himself off of his lifeboat prison, enabling
Navy shooters onboard the destroyer a clear shot at his captors - and none
was taken.

The guidance from National Command Authority - the president of the United
States, Barack Obama - had been clear: a peaceful solution was the only
acceptable outcome to this standoff unless the hostage's life was in clear,
extreme danger.

The next day, a small Navy boat approaching the floating raft was fired on
by the Somali pirates - and again no fire was returned and no pirates
killed. This was again due to the cautious stance assumed by Navy personnel
thanks to the combination of a lack of clear guidance from Washington and a
mandate from the commander in chief's staff not to act until Obama, a man
with no background of dealing with such issues and no track record of
decisiveness, decided that any outcome other than a "peaceful solution"
would be acceptable.

After taking fire from the Somali kidnappers again Saturday night, the
on-scene-commander decided he'd had enough.

Keeping his authority to act in the case of a clear and present danger to
the hostage's life and having heard nothing from Washington since yet
another request to mount a rescue operation had been denied the day before,
the Navy officer - unnamed in all media reports to date - decided the AK47
one captor had leveled at Philips' back was a threat to the hostage's life
and ordered the NSWC team to take their shots.

Three rounds downrange later, all three brigands became enemy KIA and
Philips was safe.

There is upside, downside, and spinside to the series of events over the
last week that culminated in yesterday's dramatic rescue of an American
hostage.

Almost immediately following word of the rescue, the Obama administration
and its supporters claimed victory against pirates in the Indian Ocean and
[1] declared that the dramatic end to the standoff put paid to questions of
the inexperienced president's toughness and decisiveness.

Despite the Obama administration's (and its sycophants') attempt to spin
yesterday's success as a result of bold, decisive leadership by the
inexperienced president, the reality is nothing of the sort.

What should have been a standoff lasting only hours - as long as it took the
USS Bainbridge and its team of NSWC operators to steam to the location -
became an embarrassing four day and counting standoff between a ragtag
handful of criminals with rifles and a U.S. Navy warship.

Thursday, April 16, 2009

NBC Brass Doesn't Like All The Obama-Bashing On CNBC

Apparently, the right-wing tone of CNBC -- which has provided a platform towards tea protesters and tips on Obama-proofing your portfolio -- isn't going over well at NBC corporate.

Top talent and execs at the network were ordered to a three-hour meeting, organized by Jeff Zucker, to discuss the issue, reports Page Six.

"It was an intensive, three-hour dinner at 30 Rock which Zucker himself was behind," a source familiar with the powwow told us. "There was a long discussion about whether CNBC has become too conservative and is beating up on Obama too much. There's great concern that CNBC is now the anti-Obama network. The whole meeting was really kind of creepy."

One topic under the microscope, our insider said, was on-air CNBC editor Rick Santelli's rant two months ago about staging a "Chicago Tea Party" to protest the president's bailout programs -- an idea that spawned tax protest tea parties in other big cities, infuriating the White House. Oddly, Santelli was not at the meeting, while Jim Cramer was, noted our source, who added that no edict was ultimately handed down by the network chieftains.

For its part, the network denied that the meeting had anything to do with the political tone of the network.

We could see the politics of CNBC alienating some viewers, but from our perspective it seems to provide a nice counterweight to its sister network MSNBC, which has basically become Air America on TV. But at least at this point, with Obama still riding very high, and big business running very low that's probably just the right stance to take.

According to Page Six, no official policy was handed down at the meeting.

Friday, April 3, 2009

Late night humor 4-2-09

President Obama and First Lady Michelle Obama met the Queen of England. As a gift, they gave the Queen an iPod. I guess she can use that while she’s jogging. And she likes it. She said it’s so much easier to use than that giant boom box she used to carry around.

So they gave the Queen an iPod. I remember when British Prime Minister Gordon Brown was here, the Obamas gave him a DVD box set. So, it looks like they’re saving the big gift, the Nintendo, for the Pope.

People in England are lining up by the thousands to see President Obama, because this is really different for them. They’ve never seen someone like him — a 47-year-old man with a full set of perfect teeth.

Do you know that over 500 administrative staff members traveled to London with the President? Not for the summit. They just want to be out of the country during tax time.

At the big G-20 summit, President Obama met with the Chinese president, and they had the traditional exchanging of gifts. The Chinese do that. They exchange gifts. President Hu Jintao gave President Obama a gift made in China, and President Obama gave Hu a gift from America made in China.

How’s this for hypocrisy? While Congress has been chastising companies for giving out bonuses, last year, members of Congress gave out over $9 million in bonuses, paid for by the taxpayer, to their staff. But Congress is saying they’re not hypocrites because this extra money they give their staff really isn’t bonus money. It’s hush money. They just call it bonus money for legal reasons.

And months after Alaska Senator Ted Stevens was convicted for taking illegal gifts and lost his re-election, the Justice Department now wants all charges dropped. Apparently, there was such misconduct by the prosecution that he’s going to be a free man and he gets to keep all the gifts. When he heard that, Rod Blagojevich announced he is moving to Alaska.

And the U.S. government has launched a Web site to help people deal emotionally with this economic crisis. The site is for people who experience depression, crying, and anxiety. In fact, the first person to log on the Web site was Treasury Secretary Timothy Geithner.

And according to MSNBC, experts say insomnia can double your risk of suicide. Well, that’ll help you fall asleep.

Political humor

President Obama is in London but he is still following his Final Four - Chase, Wells Fargo, JP Morgan and Bank of America.

Scientists are working on a drug to cure kleptomaniacs. They admit such an remedy should have been perfected years ago. But for some reason, the formula in the lab kept disappearing.

Barack Obama made his first trip as president to England. Here is my question. If the President is in England, who’s running General Motors?

As you know by now, the government is now taking an active role in the auto business. President Obama offering hope, change, and 0 percent financing.

You know what’s interesting? Today, a reporter in Crawford, Texas, asked former President George Bush how he felt about General Motors and Bush said, “You know, since I left office, I don’t really follow the Iraq war anymore.”

Actually, President Obama says that G.M. filing for bankruptcy may be the best alternative. He said that bankruptcy is a good legal tool for a company not to have to pay creditors back, which sounds great until you realize, hey wait a minute, we’re the creditors! Great, so you want to help them not pay us back. I mean, even A.I.G. is going, “Why didn’t we think of this?”

So, it’s pretty crazy. Look, we’re bailing out Wall Street, we’re bailing out banks, we’re bailing out car companies. In fact, did you know there’s a special box on your tax form this year you can check if you want a portion of your taxes to actually go to running the government?

And there was kind of an awkward moment yesterday as President Obama was leaving to go to the G-20 summit. Hillary Clinton called and said, “Can I run the country while you’re gone? Please, can I?”

Thousands of people showed up in London to protest this G-20 economic summit. Protesters smashed windows at the Bank of Scotland. Did you see it on the news? The banks were closed. The windows were all boarded up. It looked like our banks.

A British genealogist who traced President Obama’s roots claimed Obama is related to the royal family. Well, did you see President Obama standing with Prince Charles? If those ears are any indication, I think they may be related.

And more embarrassment for the President. Just a few weeks after President Obama named Kansas Gov. Kathleen Sebelius as his Health and Human Services nominee, she now reveals she owes over $7,000 in back taxes. Another one owes. See, that’s the difference between the two political parties right there. Republicans believe in no new taxes. Democrats believe in no old ones.

And China says it wants to replace the U.S. dollar with a new global currency. They want to move from a gold-based standard to a lead-based standard.

And from the animal kingdom, it seems a loggerhead sea turtle nearly swam to the doorstep of a Florida Keys turtle hospital. This is the only licensed veterinary facility in the world that solely treats sea turtles. This turtle somehow knew to swim right up to the hospital. Isn’t that amazing? Sad part, they had to turn him away when his H.M.O. wouldn’t cover the visit.

Anybody here got a General Motors car? Well, look out for this guy, this Barack Obama. He comes in, doesn’t like what he sees at General Motors and tells the C.E.O., Rick Wagoner, to take a hike. Wagoner, however, got a $20 million bonus. But the good news is the 20 million was in G.M. stock.

Britain’s Prime Minister, Gordon Brown, asked President Obama if he ever played darts. And Obama said: “Sure I play darts. How do you think I picked my Cabinet?”

Thursday, April 2, 2009

Introducing the Government-Backed DMV Automotive Repair Center!

Stop worrying about the warranty on your GM or Chrysler automobile.

President Obama has announced that your warranty will be backed by the US Government. Now, getting service will be as easy as a trip to your local DMV office

Introducing the Department of Motor Vehicles Automotive Repair Center!

Where have you gone, Mr. Jefferson?